Healthcare Provider Details

I. General information

NPI: 1598862708
Provider Name (Legal Business Name): MILS HOME HEALTH CARE AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6053 HUDSON RD STE 200
WOODBURY MN
55125-1000
US

IV. Provider business mailing address

6053 HUDSON RD STE 200
WOODBURY MN
55125-1000
US

V. Phone/Fax

Practice location:
  • Phone: 612-379-4027
  • Fax: 612-379-3489
Mailing address:
  • Phone: 612-379-4027
  • Fax: 612-379-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number330410
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID MICHAEL BENNEROTTE
Title or Position: CEO
Credential:
Phone: 507-269-1726